Subscribe to RSS
DOI: 10.1055/s-2008-1077112
© Georg Thieme Verlag Stuttgart · New York
Diagnose der Tuberkulose in der klinischen Praxis - Aktuelle Übersicht relevanter Methoden
Diagnosis of tuberculosis in clinical practice - An update of relevant methodsPublication History
Publication Date:
08 May 2008 (online)
![](https://www.thieme-connect.de/media/klinikarzt/200804/lookinside/thumbnails/10.1055-s-2008-1077112-1.jpg)
Die Tuberkulose gehört zu den häufigsten zum Tode führenden Infektionskrankheiten weltweit. Auf dem Gebiet der Diagnostik der Tuberkulose hat es in den vergangenen Jahren bedeutende Fortschritte gegeben. Heute beruht die Diagnose der Tuberkulose - neben der Erhebung der Anamnese und der körperlichen Untersuchung - auf den Resultaten radiologischer, mikrobiologischer, immunologischer, molekularbiologischer und histologischer Verfahren. Die zusammenfassende Betrachtung der Untersuchungsergebnisse dieser unterschiedlichen Methoden ermöglicht in aller Regel eine schnelle und zuverlässige Therapieentscheidung. Die kulturelle Sicherung von Mycobacterium tuberculosis bleibt dabei der Goldstandard der Tuberkulosediagnostik und ist für eine Antibiotika-Sensibilitätstestung unbedingt erforderlich.
Tuberculosis ranges among the major cause of death by infectious diseases worldwide. Recently, major advances have been made in the diagnosis of tuberculosis. Today, the diagnosis of tuberculosis relies on a comprehensive medical history and clinical examination as well as on the results of radiological, microbiological, immunological, molecular-biological and histological methods. When taken together, results of these examinations allow a rapid and reliable diagnosis or exclusion of tuberculosis for early treatment interventions. However, confirmation of the growth of Mycobacterium tuberculosis by culture remains the gold-standard in the diagnosis of tuberculosis and culture confirmation is necessary for reliable antibiotics sensitivity testing.
Key words
diagnosis - Mycobacterium tuberculosis - TIGRA - tuberculosis
Literatur
- 1 Abebe F, Holm-Hansen C, Wiker HG, Bjune G.. Progress in serodiagnosis of Mycobacterium tuberculosis infection. Scand J Immunol. 2007; 66 176-191
- 2 Brock I, Weldingh K, Lillebaek T. et al. . Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am J Respir Crit Care Med. 2004; 170 65-69
- 3 Corbett EL, Marston B, Churchyard GJ, De Cock KM.. Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet. 2006; 367 926-937
- 4 Daniel TM.. The rapid diagnosis of tuberculosis: a selective review. J Lab Clin Med. 1990; 116 277-282
- 5 De Backer AI, Mortelé KJ, Vanhoenacker RM, Parizel PM.. Imaging of extraspinal musculoskeletal tuberculosis. Eur J Radiol. 2006; 57 119-130
- 6 Dheda K, Chang JS, Kim LU. et al. . Interferon gamma assays for tuberculosis. Lancet Infect Dis. 2005; 5 325-327
- 7 Dheda K, Udwadia ZF, Huffett JF. et al. . Utility of the antigen-specific interferon-gamma assay for the management of tuberculosis. Curr Opin Pulm Med. 2005; 11 195-202
- 8 Diel R, Ernst M, Döscher G. et al. . Avoiding the effect of BCG vaccination in detecting Mycobacterium tuberculosis infection with a blood test. Eur Respir J. 2006; 28 16-23
- 9 Diel R, Forssbohm M, Loytved G. et al. . Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose. Gesundheitswesen. 2006; 69
- 10 Diel R, Nienhaus A, Lange C. et al. . Tuberculosis contact investigation with a new, specific blood test in a low-incidence population containing a high proportion of BCG-vaccinated persons. Respir Res. 2006; 7
- 11 Diel R, Schneider S, Meywald-Walter K. et al. . Epidemiology of tuberculosis in Hamburg, Germany: long-term population-based analysis applying classical and molecular epidemiological techniques. J Clin Microbiol. 2002; 40 532-539
- 12 Dinnes J, Deeks J, Kunst H. et al. . A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. Health Technol Assess. 2007; 11 1-196
- 13 Ewer K, Deeks J, Alvarez L. et al. . Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet. 2003; 361 1168-1173
- 14 Forssbohm M, Zwahlen M, Loddenkemper R, Rieder HL.. Demographic characteristics of patients with extrapulmonary tuberculosis in Germany. Eur Respir J. 2008; 31 99-105
- 15 Gopi A, Madhavan SM, Sharma SK, Sahn SA.. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest. 2007; 131 880-889
- 16 Hernandez-Garduno E, Cook V, Kunimoto D. et al. . Transmission of tuberculosis from smear negative patients: a molecular epidemiology study. Thorax. 2004; 59 286-290
- 17 Jafari C, Ernst M, Kalsorf B. et al. . Rapid diagnosis of smear-negative tuberculosis by bronchoalveolar lavage enzyme-linked immunospot. Am J Respir Crit Care Med. 2006; 174 1048-1054
- 18 Jafari C, Ernst M, Strassburg A. et al. . Local immunodiagnosis of pulmonary tuberculosis by enzyme-linked immunospot. Eur Respir J. 2007; 31 261-265
- 19 Keeler E, Perkins MD, Small P. et al. . Reducing the global burden of tuberculosis: the contribution of improved diagnostics. Nature. 2006; 444 49-57
- 20 Klautau GB, Kuschnaroff TM.. Clinical forms and outcome of tuberculosis in HIV-infected patients in a tertiary hospital in Sao Paulo - Brazil. Braz J Infect Dis. 2005; 9 464-478
- 21 Kösters K, Nau R, Bossink A. et al. .Rapid diagnosis of CNS tuberculosis by a T-Cell interferon-gamma release assay on cerebrospinal fluid mononuclear cells. Infection 2008
- 22 Lange C, Hellmich B, Ernst M, Ehlers S.. Rapid immunodiagnosis of tuberculosis in a woman receiving anti-TNF therapy. Nat Clin Pract Rheumatol. 2007; 3 528-534
- 23 Lange C, Schaberg T, Diel R. et al. . Aktueller Stand der Tuberkulosediagnostik. Dtsch Med Wochenschr. 2006; 131 341-347
- 24 Langemeier J.. Tuberculosis of the genitourinary system. Urol Nurs. 2007; 27
- 25 Lee MP, Chan JW, Ng KK, Li PC.. Clinical manifestations of tuberculosis in HIV-infected patients. Respirology. 2000; 5 423-426
- 26 Losi M, Bussink A, Codecasa L. et al. . Use of a T-cell interferon-{gamma} release assay for the diagnosis of tuberculous pleurisy. Eur Respir J. 2007; 30 1173-1179
- 27 Menzies D, Pai M, Comstock G.. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. 2007; 146 340-354
- 28 Pai M, Gokhale K, Joshi R. et al. . Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA. 2005; 293 2746-2755
- 29 Pai M, Riley LW, Colford Jr. JM. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis. 2004; 4 761-776
- 30 Perkins MD, Cunningham J.. Facing the crisis: improving the diagnosis of tuberculosis in the HIV era. J Infect Dis. 2007; 196
- 31 Robert-Koch-Institut, Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2005. Berlin. 2007
- 32 Roth A, Schaberg T, Mauch H.. Molecular diagnosis of tuberculosis: current clinical validity and future perspectives. Eur Respir J. 1997; 10 1877-1891
- 33 Rothel JS, Andersen P.. Diagnosis of latent Mycobacterium tuberculosis infection: is the demise of the Mantoux test imminent?. Expert Rev Anti Infect Ther. 2005; 3 981-993
- 34 Shams H, Weis SE, Klucar P. et al. . Enzyme-linked immunospot and tuberculin skin testing to detect latent tuberculosis infection. Am J Respir Crit Care Med. 2005; 172 1161-1168
- 35 Sharma SK, Mohan A.. Extrapulmonary tuberculosis. Indian J Med Res. 2004; 120 316-353
- 36 Sokal JE.. Editorial: Measurement of delayed skin-test responses. N Engl J Med. 1975; 293 501-502
- 37 Steingart KR, Henry M, Laal S. et al. . A systematic review of commercial serological antibody detection tests for the diagnosis of extrapulmonary tuberculosis. Thorax. 2007; 62 911-918
- 38 Strassburg A. et al. .Rapid diagnosis of pulmonary tuberculosis by BAL-ELISPOT in an immunocompromised host. Eur Respi J 2008
- 39 Warren JR, Bhattacharya M, De KN Almeida. et al. . A minimum 5.0 ml of sputum improves the sensitivity of acid-fast smear for Mycobacterium tuberculosis. Am J Respir Crit Care Med. 2000; 161 1559-1562
- 40 WHO, World Health Organization. .Global tuberculosis control: surveillance, planning, financing. WHO report, Geneva 2006
- 41 WHO, World Health Organization. .Global tuberculosis control: surveillance, planning, financing. WHO report, Geneva 2006
- 42 WHO, World Health Organization. .Tuberculosis Fact Sheet No. 2007
- 43 Willcox PA, Potgieter PD, Bateman ED, Benatar SR.. Rapid diagnosis of sputum negative miliary tuberculosis using the flexible fibreoptic bronchoscope. Thorax. 1986; 41 681-684
1 Enzyme Linked ImmunoabSorbant Assay
3 mycobacterial growth indicator tube
Korrespondenz
PD Dr. Dipl.-Biol. Christoph Lange
Klinische Infektiologie Medizinische Klinik Forschungszentrum Borstel
Parkallee 35
23845 Borstel
Email: clange@fz-borstel.de